Endometriosis has been classified as an immune deficiency disease (“Pathogenesis of Endometriosis: Natural Immunity Dysfunction or Autoimmune Disease,” Trends Mol Med., 9(5):223-8, May 2003, G. Matarase, G. De Placido, Y. Nikas, C. Alviggi) that affects approximately seven (7) percent of the pre-menopausal women worldwide in their reproductive years and accounts for twenty-three (23) percent of female fertility issues (www.mindbranch.com/products). The annual healthcare costs and costs of productivity loss associated with endometriosis were estimated as $22 billion for 2002. Endometriosis: cost estimates and methodological perspective, Hum. Reprod. Update (2007) 13(4):395-404, S. Simoens, L. Hummelshoj, T. D'Hooghe.
Endometriosis is characterized by ectopic lesions of endometrial tissue in various organs of the body outside the uterine cavity. Harvard Medical School Family Health Guide (1999) 1071, A. Komaroff. Ectopic lesions of endometrial tissue are typically found on the ovaries, fallopian tubes, ligaments that support the uterus, areas around the vagina and uterus, and areas within the peritoneal and pelvic cavities. The ectopic lesions form benign tumors on organs which can lead to inflammation, severe discomfort and pelvic pain, and reproductive failure. (www.coobgyn.com/pt/re/coobgyn/abstract)
The ectopic endometrial lesions are similar to endometrial tissue which lines the uterus. Unlike endometrial tissue lining the uterus, however, ectopic endometrial lesions are unable to discharge from the body during menstruation. Internal bleeding results from the ectopic endometrial lesions, leading to the development of inflammation and scar tissue. One theory is that the ectopic lesions are thought to result from transport of endometriotic stem cells present in menstrual flow. Uterine stem cells: what is the evidence, Human Reproduction Update (2007), 13(1):87-101, C. E. Gargett. The stem cells can implant in other tissues that have growth factors and steroid hormone receptors which facilitate growth and development of blood vessels, nerves, and tissue within the implanted endometriotic tumors. Endometriotic tumors that develop in the pelvic cavity and the fallopian tubes are known to have steroid receptors and other growth factors that can facilitate growth and development of these misplaced endometriotic stern cells. Endometrial Stem Cells and Endometriosis, Jafar Ai and Esmaeil Sadroddiny Endometriosis—Basic Concepts and Current Research Trends, Department of Tissue Engineering, School of Advanced Medical Technologies, Tehran University of Medical Sciences, Tehran, Iran.
Endometriosis presents difficulties in diagnosis. The typical problems of pelvic pain and infertility are non-specific. Although endometriosis is one of the leading causes of infertility in women, it is estimated that less than half of women with endometriosis suffer from fertility problems. (www.healthywomen.org/healthtopics/endometriosis/q/L2/24/L1/3//) While the above-discussed increased sensitivity brought about by inflammation, scar tissue, and nerve tissue growth manifests as discomfort or severe pain, not all women afflicted with endometriosis experience the severe pain, and oftentimes severe pelvic pain can be attributed to causes other than endometriosis. (www.healthywomen.org/healthtopics/endometriosis/q/L2/24/L1//) Other symptoms of endometriosis may include diarrhea, intestinal pain, painful intercourse, abdominal tenderness, cramping, back ache, menstrual cramps, and excessive menstrual bleeding. These symptoms are not universally experienced throughout the population of females having endometriosis, and can be brought about by other illnesses and conditions such as fibroids and cysts.
The only accepted method for diagnosing endometriosis is laparoscopy of the pelvic cavity. However, laparoscopy is costly, invasive, and generally cannot be carried out without a trained specialist and expensive equipment. The high cost, inconvenience, and physical risks associated with laparoscopy can cause women to delay or decide against screening until symptoms become severe. Many attempts have been made to introduce simple non-invasive diagnostics for endometriosis. However, so far no method has been able to accurately diagnose endometriosis with as high of a degree of sensitivity or specificity than what has been documented with laparoscopy.
Many types of biomarkers such as CA-125, Tumor Necrosis Factor TNFα, CA19-9, E-cadherin, TIMP1, or MMP2, or autoimmune factors such as Il-8 known to be in elevated concentrations in women with endometriosis have been evaluated as potential serum markers for endometriosis. However, these markers are also elevated in certain cancers and are not specific to endometriosis. Furthermore, the markers are serum based and require regulated laboratory conditions for testing specimens.
A simple, low cost, non-invasive diagnostic that can test a biological sample of a female directly in the doctor's office, and preferably at home, for endometriosis would offer significant medical benefits towards promoting early detection diagnosis, decreasing medical costs associated with diagnosis and treatment, and enhancing valid population-based research.